5 reasons why gay men get more STIs (and what we can do about it)

Matthew Hodson

The latest syphilis figures from Public Health England make for some pretty grim reading. Over the last five years the number of syphilis cases have increased by 232%. Once again gay and bisexual men are most affected.

Although gay and bisexual men probably account for less than 3% of the population, we punch way above our weight as a proportion of all STIs. The recent figures show that 90% of new syphilis diagnoses in 2015 were among men who have sex with men. Particularly high incidence of syphilis was observed among gay and bi men in London and among men living with HIV.

Why are we such over-achievers? Here are five reasons why gay and bi men top the STIs charts.

First of all the good news: some of that rise is due to more tests being carried out. There’s still some way to go before we get handed gold stars but we gay men are generally better at getting ourselves checked out on a regular basis than our hetero brothers. And GUM clinic staff have got better about asking the right questions and checking in the right places – anal gonorrhoea can easily go undetected unless they know to check your bum. Whoop!

Less likely to get the Daily Mail running up to shake our hands and congratulate us though is reason number two:one of the main reasons for our domination in this field is that we’re more likely than our hetero brethren to have lots (and possibly LOTS) more sexual partners.

Yes, I’m pretty certain right now some of you are shaking your fist at the screen or saying “Not me”. Well bully and congrats for you. Of course there’s considerable diversity in the number of sexual partners that gay men have but, even if it’s not your own behaviour that’s creating the challenge, the challenge remains. In recent years it has become much easier for us to meet other gay men and to have sex with lots of them. Dating apps and chem-fuelled sex parties mean that infections can be spread efficiently to large numbers of men in a very short time. Maybe the proportion of us who have lots of sexual partners hasn’t changed, but if sexual variety rather than sexual fidelity is your particular bag, it’s got that much easier.

Thirdly, condom use among gay men is declining. It’s not going down dramatically, and gay men are more likely to use condoms than heterosexuals, but it is going down. Often people stop using condoms because they’re in a relationship. Often gay men stop using condoms because they’ve been diagnosed with HIV, and are having sex (most usually) with men who they believe, or assume, to also be living with HIV.

Since the mid-1980s, our sexual health has been popularly defined in terms of HIV. When there was no effective treatment and thousands of gay men were dying of AIDS it felt as though none of the other STIs was that important. What’s more, a perception that HIV was pretty much the worst thing that could happen to your sexual health, may have inadvertently led to men diagnosed with HIV feeling that there was no longer anything significant for them to protect themselves from.

Over half of the syphilis diagnoses in the latest figures were among men living with HIV. A man living with HIV man who only has condomless sex with other HIV-positive men risks transmission of a wide range of STIs, not only syphilis but also gonorrhoea, shigella and LGV.

Fourthly, gay men are disadvantaged when it comes to STIs because of other disadvantages that we may face. We’re fighting hard to get LGBT inclusive Sex and Relationships Education into every school but we’re not there yet. Young gay men still regularly encounter prejudice, bullying and homophobic violence, making it harder for us to ask the questions which are most pertinent to our own lives and our own risks.

Finally, do we care enough? I’m not sure that we do. The battle to prevent HIV infections led to a lot of work being done within the community (including the founding of GMFA) but the broader battleground of gay men’s health inequality has not had the same resonance. Gay men are more likely to smoke. We are more likely to drink and to take drugs. We have higher rates of cardiovascular disease, asthma and diabetes. We are more likely to take our own lives and to self-injure and to experience depression or anxiety. The list of health inequalities is long and is all too often overlooked.

None of these inequalities are insignificant. Our health, and our sexual health challenges, go far beyond HIV. Most other STIs are far easier to pick up than HIV. There are STIs which aren’t HIV that are also incurable (herpes). There are STIs which aren’t HIV that can be fatal if not treated (syphilis). There are STIs which are becoming resistant to the drugs that we use to treat them (gonorrhoea).

Condoms can prevent the transmission of syphilis (as well as most other STIs). Reducing the number of sexual partners you have would also make infection less likely, and fewer overlapping sexual partners would mean that infections, including syphilis, would spread less rapidly. The use of dating apps, darkrooms and saunas and chemsex have all been associated with the recent rise in syphilis.

Use of PrEP only protects against HIV infection; it won’t prevent syphilis. One of the benefits of PrEP being made available on the NHS would be that men at high risk of acquiring STIs, would be tied in to clinical services and would be tested regularly and, if necessary, treated promptly.

The good news is that syphilis is very treatable. Unfortunately it’s easy not to notice the symptoms, which is why it’s vital that all sexually active gay men get tested at least once a year, or every couple of months, if you have sex without condoms with new partners. If you do get diagnosed with syphilis, do what you can to ensure that all of your sexual partners over the last three months are made aware, and get tested too.

It’s a major shift for us to be worrying about STIs which aren’t HIV. Unless we’re happy to continue to be the minority group with the majority of STI infections we need to look at what we do, why we do it and how we can make it better and safer for all of us.

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